Maintenance Of Continence Research Articles

30 - GABAergic neurons in the periaqueductal gray are involved in the maintenance of continence

30 - GABAergic neurons in the periaqueductal gray are involved in the maintenance of continence

Correlation between self-perception of pelvic floor muscle activity and electromyography

Background: In the pelvis we find the pelvic floor muscles (PFM), and these are responsible for supporting the pelvic organs, sexual function and maintenance of continence. Lack of awareness of this musculature can lead to incorrect contraction and relaxation failure resulting in possible dysfunctions. Aims: To correlate female selfperception of PFM movements with electromyographic data. Method: cross-sectional study. During the lecture, the women answered whether they knew how to contract and relax their PFM, and whether or not they chose to participate in the physical assessment through electromyography. During the EMG it was necessary to contract and relax the pelvic floor. Results: Of all the participants, 66.7% said they knew how to relax and 50% said they knew how to relax, but the EMG showed that 75% did not obtain an effective contraction and 83.3% did not know how to relax properly. Conclusion: the lack of female self-perception of PFM activity is a fact, given that the participants believed they knew how to contract and relax, but the EMG showed the opposite.

MP59-08 WATERJET ABLATION THERAPY (AQUABEAM) VS. URETHRAL-SPARING ROBOT-ASSISTED SIMPLE PROSTATECTOMY FOR LARGE PROSTATE VOLUMES (>80ML): RESULTS OF A MULTICENTRIC SERIES ACCORDING TO THE STANDARDIZED BPH6 ACHIEVEMENT

MP59-08 WATERJET ABLATION THERAPY (AQUABEAM) VS. URETHRAL-SPARING ROBOT-ASSISTED SIMPLE PROSTATECTOMY FOR LARGE PROSTATE VOLUMES (>80ML): RESULTS OF A MULTICENTRIC SERIES ACCORDING TO THE STANDARDIZED BPH6 ACHIEVEMENT

ROLE OF MRI IN EVALUATION OF GRADE IV PERIANAL FISTULA (ACCORDING TO SAINT JAMES'S UNIVERSITY HOSPITAL CLASSIFICATION)

Introduction- Fistula-in-ano can be dened as a hollow tract or cavity which is lined by granulation tissue. It is crucial to properly assess these stula-in-ano because surgical intervention must be aimed at not only eradication of stulous tract thereby eradication of source of infection but also at the maintenance of continence which depends on intergrity of anal-sphincter complex. MR stulography has the distinct advantage of not only depicting the stulous tract but also in demonstrating the extent of transmural inammatory process secondary tracts/ramications and abscesses. The aim of the study is to evaluate role of MRI in appropriate diagnosis of Grade IV perianal stulae – Complicated transsphincteric stulae (Saint James's University Hospital Classication) with its post operative correlation. Around 19 patients who were Methodologydiagnosed with grade IV perianal stula (according to Saint James classication) on MR stulogram in the Department of Radiology were included in the study and followed up with their post operative data. A male preponderance Results And Discussion - reported in our study, correlating well with studies by others like Kakani SS et al., Daabis N et al. and Abbas et al. Purulent perianal discharge was common presenting complaints. Most common location for internal opening was posterior position which was also seen in a study by Choudhary J, Kaushal L, Rajput P. Out of the total 19 patients, extrasphincteric abscess/collection was more commonly found in the patients. Majority of the patients had secondary tracts and ramications. In this study accuracy for correct localization of internal opening was (93.33%), identication of ramications/secondary tracts was (92.85 %) and abscesses/collection was (90 %) as compared to operative ndings which correlated well with studies by Singh K et al., Daabis et al. and Madireddy et all MRI is a useful modality for diagnosis and successful mana . Conclusion- gement of grade IV perianal stula. MRI helps in detailed assessment of the number & extent of the stulous tracts and their relationship to anal sphincter complex, including ramications, thereby reducing the recurrence & complications and improving the prognosis.

Contribution of the clinical nurse specialist in urodynamics to continence maintenance

The maintenance of continence is an objective of care that should not be neglected, especially with elderly patients. This care can be carried out through the first line nursing consultation or during the second line consultation. The main interest of it is to prevent, detect or treat a vesico-sphincter disorder that can cause anxiety, shame and isolation. The urodynamics nurse mobilizes her skills in the implementation of care actions, particularly in self-care education.

A comparative study between rubber band ligation and local application of herbal caustic compound (pratisaraneeya kshara) in management of internal haemorrhoids

Image 1071765.

Analysis of the Learning Curve of Surgeons without Previous Experience in Laparoscopy to Perform Robot-Assisted Radical Prostatectomy

Objective To assess the learning curve in robot-assisted radical prostatectomy (RARP) performed by surgeons without previous experience in laparoscopic prostatectomy. Materials and Methods We analyzed 119 patients submitted to RARP performed by two surgeons without previous experience in laparoscopic prostatectomy, with emphasis on the relevant outcomes such as continence, erectile function, and oncologic control with a minimum follow-up of 24 months. We used Fisher's exact test and the chi-square test to investigate the existence of a relationship between the variables and analysis of variance (ANOVA) to verify possible statistically significant differences between groups, at the 5% level. Results The patients' age varied from 41 to 72 years (mean = 61.09), with 68 (57.14%) cases having intermediate or high risk. There was a consistent decline in operative time. Of the 119 patients, 80.67% were continent 6 months after surgery and 89.07% 12 months afterward, while 35.29% were potent 6 months after surgery and 60.50% 12 months following surgery. Twelve months after surgery, the trifecta outcome rate was 51.26% and the pentafecta rate was 31.09%. There was progressive postoperative improvement and maintenance of continence and sexual potency until the last patient was operated in our sample. Conclusions Robot-assisted radical prostatectomy does not require previous experience in laparoscopic radical prostatectomy, but the learning curve is not short to achieve the plateau.

Avaliação da sinergia abdomino-pélvica durante atividades funcionais em mulheres nulíparas: série de caso

INTRODUÇÃO: É relevante compreender que as disfunções do assoalho pélvico (DAP) feminino são condições clínicas que acometem um número crescente de mulheres a cada ano, constituindo um problema de saúde pública. DAP podem ter relação com o desequilíbrio entre a sobrecarga tensional dessa musculatura e a diminuição da capacidade desses músculos em suportar o aumento da pressão nessa região, uma vez que essa musculatura deve se contrair durante qualquer atividade que promova o aumento da pressão intra-abdominal favorecendo a manutenção da continência. OBJETIVO: analisar a presença desta sinergia em três voluntárias descrevendo o comportamento da atividade eletromiográfica de músculos localizados no assoalho pélvico e no abdome durante as atividades funcionais: andar, sentar/levantar, segurar peso, agachar, pular e tossir. MATERIAIS E MÉTODOS: Série de três casos, envolvendo voluntárias jovens universitárias nulíparas, sem queixas miccionais. Foi mensurado o registro da atividade eletromiográfica dos músculos do assoalho pélvico e o grupo muscular formado pelo transverso abdominal e oblíquo interno durante as atividades funcionais, utilizando a eletromiografia de superfície. RESULTADOS: O sinal eletromiográfico aumentou em relação ao repouso durante as atividades funcionais de tossir, pular, agachar, sentar/levantar, segurar peso e andar em ambas as musculaturas analisadas. As maiores atividades eletromiográficas foram observadas durante as atividades de pular e agachar, e as menores ao segurar peso, andar e sentar/levantar. CONCLUSÕES: A partir da coleta eletromiográfica dos músculos transverso abdominal/ oblíquo interno e esfíncter anal externo em três voluntárias nulíparas foi possível observar sinergia destas musculaturas durante as atividades funcionais propostas. Estudos que envolvam grupos maiores de voluntárias, são necessários para podermos afirmar as respostas sobre a sinergia entre esses grupos musculares durante as atividades funcionais.

Anal incontinence in patients with fistula-in-ano: a comparative study between LIFT (ligation of inter-sphincteric fistulous tract) and fistulectomy

Background: General surgeons perform surgeries for Fistula in ano day in and day out as elective procedures. Fistula in ano is more common nowadays because of improper hygiene. 3 major basic aims of Fistula in ano surgeries are control of sepsis closure of fistula and maintenance of continence. Post operatively some patients developed anal incontinence due to sphincter injury which affects patients’ day to day activity. The present study compared the utility and effectiveness of two standard procedures LIFT (Ligation of Intersphincteric Fistula Tract) and Fistulectomy in terms of anal incontinence.Methods: This study included 100 patients with fistula in ano during the 6 months period from January 2017 to June 2017. Randomized controlled trial was done to divide the patients into two groups. Group A underwent fistulectomy and Group B underwent LIFT (Ligaton of intersphincteric fistulous tract). Post-operative anal incontinence between the two groups were observed for 6 months.Results: In our study it was observed that four patients of group A (fistulectomy) had anal incontinence whereas no patients in group B (LIFT) developed anal incontinence.Conclusions: LIFT (Ligation of intersphincteric fistulous tract) is a better procedure when compared to fistulectomy in preserving sphincter function and preventing anal incontinence offering better quality of life.

An in-house Composix™-based pubovaginal sling trial for female stress urinary incontinence: Five-year comparative followup to tension-free and transobturator vaginal tapes.

We compared the efficacy of three slings in the long-term treatment of stress urinary incontinence (SUI): tension-free vaginal tape (TVT), vaginal tape-obturator (TVT-O), and an in-house two-layered polypropylene mesh with a submicronic polytetrafluoroethylene (Composix™). Our primary endpoint was the objective measurement of continence (24-hour pad test). Secondarily, we measured the satisfaction and complication rates. This prospective, non-randomized study included 128 patients with SUI. Preoperative evaluation included medical history, physical exam, 24-hour pad test, Urinary Incontinence Quality of Life Scale (IQOL), FPSUND, and global satisfaction questionnaires. Patients were followed at one month postoperative, biannually for two years, and then annually for a total of five years. Followup visits included a focused questionnaire, physical exam, satisfaction questionnaire, 24-hour pad test, IQOL, and FPSUND questionnaires. Composix, TVT, and TVT-O groups included 60, 34, and 34 patients, respectively. No significant differences were found in baseline characteristics except for the pad test. Length of catheterization was the only immediate operative significant parameter (Composix 4.7 days vs. TVT 1.1 days vs. TVT-O 2.6 days; p=0.03). The entire cohort had significant improvements in their IQOL, FPSUND, and pad test at one and four years (p<0.01). The cohort-wide 24-hour pad test average weight was 30.4 g preoperatively vs. 5 g at 12 months (p<0.00001) (Composix 37 to 5 g, TVT 83 to 4 g, and TVT-O 55 to 5 g). The Composix group had a higher number of minor complications (Clavien I, II) and secondary procedures. This single-surgeon cohort with five-year followup demonstrated a large improvement and maintenance of continence in all three surgical groups. The Composix-based sling provided comparable continence outcomes at a fraction of the cost; however, its increased morbidity and higher complication rate raise concerns over future use.

Inhibitory effect of the urothelium/lamina propria on female porcine urethral contractility & effect of age.

The urethral uroepithelium has been implicated in urethral sensation and maintenance of continence. However, relatively little is known about the function of the urethral urothelium compared with that of the bladder. The aim of the study was to examine the role of the urothelium/lamina propria on contractility of the porcine urethra, along with the influence of nitric oxide, prostaglandins and ageing. Porcine urethral tissues, intact and denuded of urothelium/lamina propria, were mounted in tissue baths and contractions to noradrenaline, phenylephrine and carbachol obtained. Contractions in the presence of Nώ-nitro-l-arginine (100μmol/L) and indomethacin (10μmol/L) were examined, along with contractions of tissues from young (6months) and older (3years) animals. The urothelium/lamina propria of the urethra significantly inhibited contractions to carbachol, noradrenaline and phenylephrine. This inhibitory effect was not significantly different for the three agonists (58.7±10.3%, 60.4±12.6% and 39.4±12.2% inhibition; n=4-7), and was also observed when denuded tissues were co-incubated with a second tissue with intact urothelium/lamina propria (40.6±7.5% inhibition; n=6). Inhibition of nitric oxide and prostaglandin production did not attenuate the inhibitory effect of the urothelium/lamina propria on noradrenaline contractions. In addition, ageing did not alter the inhibitory effect for either phenylephrine contractions (33.9±2.2% vs 41.0±9.7%, young vs older urethral tissues) or noradrenaline contractions (32.9±11.1% vs 53.7±11.0%). In conclusion the urothelium/lamina propria of the urethra has an inhibitory effect on receptor-mediated urethral contraction. This inhibition is due to the release of a diffusible factor, and the effect is not mediated by nitric oxide or prostaglandins, or affected by age.

FRI-13 ANATOMY OF THE PROSTATE GLAND: EVOLVING UNDERSTANDING THROUGH LAPAROSCOPIC AND ROBOTIC UROLOGICAL SURGERY

You have accessJournal of UrologyHistory of Urology: History Forum1 Apr 2017FRI-13 ANATOMY OF THE PROSTATE GLAND: EVOLVING UNDERSTANDING THROUGH LAPAROSCOPIC AND ROBOTIC UROLOGICAL SURGERY Peter Macneal, Sashi Kommu, Peter Rimington, and Harold Ellis Peter MacnealPeter Macneal More articles by this author , Sashi KommuSashi Kommu More articles by this author , Peter RimingtonPeter Rimington More articles by this author , and Harold EllisHarold Ellis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2478AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The prostate gland was ill understood until the Renaissance when anatomists discovered the organ naming it “glandulous body.” In 1600 the French physician du Laurens introduced the name “prostatae” (Josef et al. 2009). Modern insight into the anatomy of the gland was supplemented by McNeal′s description of the zonal anatomy of the prostate (1981), and by rapid surgical advances in surgical technology. This is a review of recent developments in understanding of the prostate through robotic and laparoscopic urological surgery. METHODS A systematic literature search of PubMed, Medline, EMBASE, textbook chapters and historical archives was performed. RESULTS The introduction of laparoscopic radical prostatectomy (LRP) allowed assessment of the prostate and its anatomical relations with heighted magnification and new visual angles. Robotic surgical systems further enhanced visualisation, with superior magnification and additional three-dimensional views. New anatomical understanding led to modifications of surgical technique aiming to preserve continence and potency. In 2002, it was noted that important relationships existed between pelvic plexus ganglions and seminal vesicles. Further fine neural plexuses along the posterior and antero-lateral surface of the prostate were described based on cadaveric studies and laparoscopic and robotic views. Later on, the technique of nerve preservation in which a plane (deep to the Santorinis plexus) between the prostatic capsule and inner prostatic fascial layer is developed at its cranial extent was described (i.e. the Veil of Aphrodite). In 2003-2004, Lunacek et al. noted that the cavernosal nerves running along the prostate become displaced further anteriorly and spread, thus forming a concave shape (like a ′curtain′) of the neurovascular bundles. This led to the description of the modified ′curtain dissection′ in 2005. Recently interfascial dissection of the neurovascular bundles that is tension and cautery free was described. Recent advances on microdissection robotic platforms such as mini-balloon tissue dissection could render further understanding of the anatomy of the prostate (Kommu et al. J Endourol 2009). CONCLUSIONS Laparoscopic and robotic urological surgery has had a significant impact on our understanding of the prostate gland. This evolving understanding continues to redefine surgical practices towards optimised outcomes in oncological treatment, preservation of erectile function and maintenance of continence during radical prostatectomy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1064-e1065 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Peter Macneal More articles by this author Sashi Kommu More articles by this author Peter Rimington More articles by this author Harold Ellis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Analysis of Indications and Results of Anorectal Manometry in Two Tertiary Hospitals in India

The anorectum plays an important role in regulation of defecation and in maintenance of continence [1].

The Cath-Assist: A Self-Catheterization Assistive Device1

The Cath-Assist: A Self-Catheterization Assistive Device1

Treatment of Refractory Perianal Fistulas with Ligation of the Intersphincteric Fistula Tract: Preliminary Results

Several surgical options exist for management of fistula in ano. The goal of treatment is to achieve closure of the fistula while maintaining continence. Sphincter-sparing operations to close perianal fistulas include advancement flap, anal fistula plug, fibrin glue, and fistulectomy. Variable success rates from 30 to 80 per cent have been reported. Ligation of intersphincteric fistula tract (LIFT), first described in 2007, has a reported success rate from 40 to 94 per cent. The objective of this study was to study our results of the LIFT procedure for refractory perianal fistulas. We conducted a retrospective 18-month review of consecutive patients with refractory perianal disease treated with the LIFT procedure at an academic, tertiary, colorectal practice. All patients undergoing a LIFT procedure for anal fistula from August 2010 to August 2012 were included in the study. The primary end points were success rates at 1 month and 3 months. Secondary end points were postoperative complications and maintenance of continence. Twenty patients underwent LIFT procedures of whom nine had previously failed treatments. Mean age was 45 years and included 12 male and eight female patients. Success rate at 1 month was 70 per cent (14 patients) and at 3 months was 80 per cent (16 patients). Success rates for patients with previously failed attempts were 67 per cent at 1 month and 89 per cent at 3 months. Continence was maintained in 100 per cent of patients. Our data support the use of the LIFT procedure for refractory perirectal fistulas.

Hybrid seton for the treatment of high anal fistulas: results of 128 consecutive patients

BackgroundThe aim of this study was to evaluate our experience in managing high anal fistulas with a simple modification of the cutting seton.MethodsWe performed a retrospective review of standardized patient charts and of prospectively collected scores and questionnaires. Surgical outcomes of 128 consecutive, well-documented patients with high anal fistulas, including anterior transsphincteric fistulas in females, treated using a hybrid seton, were analyzed.ResultsNo significant complications occurred. The mean postoperative pain scores on a visual analog scale were 3.23 and 0.61, on days 1 and 7, respectively. Complete healing was achieved in 67 cases (52.3 %) at 1 month and in all cases (100 %) at 3 months. Recurrent fistula was noted in 2 patients (1.5 %) at 6 and 12 months. The mean postoperative incontinence scores at 3 and 12 months did not differ significantly from the preoperative score (p = 0.061, Wilcoxon’s test). The depression, life style, and embarrassment item scores of the fecal incontinence quality of life index improved significantly after surgical treatment.ConclusionsThe results of this series suggest that the hybrid seton might be a valid alternative for the treatment of high anal fistulas, eliminating the need for postoperative adjustments. The slow and stable cutting of the sphincter seems to have a positive effect on the maintenance of continence. The successful outcome is associated with significant improvement in quality of life.

The micturition switch and its forebrain influences

Dr DeGroat and Wickens has reviewed the central neural mechanisms controlling the lower urinary tract with a major focus on the brain stem circuitry that mediates the switch-like characteristics of micturition, in particular the periaqueductal grey and the pontine micturition centre (de 2012). The review culminates in a computer model of how the brainstem switch operates in animals in which forebrain influences on micturition have been removed by decerebration. In this complementary paper, we review the mechanisms of forebrain involvement in the voluntary control of human micturition and the maintenance of continence with evidence based heavily on the results of functional brain imaging experiments.

Effect of material properties on predicted vesical pressure during a cough in a simplified computational model of the bladder and urethra.

Stress urinary incontinence is a condition that affects mainly women and is characterized by the involuntary loss of urine in conjunction with an increase in abdominal pressure but in the absence of a bladder contraction. In spite of the large number of women affected by this condition, little is known regarding the mechanics associated with the maintenance of continence in women. Urodynamic measurements of the pressure acting on the bladder and the pressures developed within the bladder and the urethra offer a potential starting point for constructing computational models of the bladder and urethra during stress events. The measured pressures can be utilized in these models to provide information to specify loads and validate the models. The main goals of this study were to investigate the feasibility of incorporating human urodynamic pressure data into a computational model of the bladder and the urethra during a cough and determine if the resulting model could be validated through comparison of predicted and measured vesical pressure. The results of this study indicated that simplified models can predict vesical pressures that differ by less than 5cmH(2)O (<10%) compared to urodynamic pressure measurements. In addition, varying material properties had a minimal impact on the vesical pressure and displacements predicted by the model. The latter finding limits the use of vesical pressure as a validation criterion since different parameters can yield similar results in the same model. However, the insensitivity of vesical pressure predictions to material properties ensures that the outcome of our models is not highly sensitive to tissue material properties, which are not well characterized.

Viscoelastic Assessment of Anal Canal Function Using Acoustic Reflectometry

Anal acoustic reflectometry is a new reproducible technique that allows a viscoelastic assessment of anal canal function. Five new variables reflecting anal canal function are measured: the opening and closing pressure, opening and closing elastance, and hysteresis. The aim of this study was to assess whether the parameters measured in anal acoustic reflectometry are clinically valid between continent and fecally incontinent subjects. This was an age- and sex-matched study of continent and incontinent women. The study was conducted at a university teaching hospital. One hundred women (50 with fecal incontinence and 50 with normal bowel control) were included in the study. Subjects were age matched to within 5 years. Parameters measured with anal acoustic reflectometry and manometry were compared between incontinent and continent groups using a paired t test. Diagnostic accuracy was assessed by the use of receiver operator characteristic curves. Four of the 5 anal acoustic reflectometry parameters at rest were significantly different between continent and incontinent women (eg, opening pressure in fecally incontinent subjects was 31.6 vs 51.5 cm H2O in continent subjects, p = 0.0001). Both anal acoustic reflectometry parameters of squeeze opening pressure and squeeze opening elastance were significantly reduced in the incontinent women compared with continent women (50 vs 99.1 cm H2O, p = 0.0001 and 1.48 vs 1.83 cm H2O/mm, p = 0.012). In terms of diagnostic accuracy, opening pressure at rest measured by reflectometry was significantly superior in discriminating between continent and incontinent women in comparison with resting pressure measured with manometry (p = 0.009). Anal acoustic reflectometry is a new, clinically valid technique in the assessment of continent and incontinent subjects. This technique, which assesses the response of the anal canal to distension and relaxation, provides a detailed viscoelastic assessment of anal canal function. This technique may not only aid the investigation of fecally incontinent subjects, but it may also improve our understanding of anal canal physiology during both the process of defecation and maintenance of continence.

Pudendal afferent innervation of the guinea pig external anal sphincter

Sensory nerves to the external anal sphincter (EAS) contribute to mechanisms promoting continence and defecation, yet we know little about their function. We investigated the function of pudendal mechanoreceptors to the guinea pig EAS. Extracellular recordings from pudendal nerve branches to 14 EAS preparations, in vitro, were used to characterize extrinsic primary afferent nerve endings activated by circumferential distension. All 42 pudendal nerve afferents were silent under non-distended conditions. Thirty-three of 42 afferents had slowly adapting, low-threshold responses to circumferential stretch that correlated with stretch length (R(2) = 0.40, P<0.001). Twenty of 20 slowly adapting afferents reduced firing when stretch was maintained for 60 s (P<0.0001). They had low thresholds to von Frey hairs (0.1-0.5mN). Firing frequency correlated with degree of compression (R(2) =0.40, P<0.0001). Nine of 42 afferents had rapidly adapting responses at the onset/offset of isometric stretch. During ramp stretch, small vibrations from the stepper motor evoked rapid bursts of firing at frequencies up to 200Hz. Instantaneous frequency was unrelated to either the rate or degree of stretch. Rapidly adapting units had low thresholds (0.1-0.2mN) to von Frey hairs and small punctate mechanotransduction sites. Responses to von Frey hair compression were also rapidly adapting, and instantaneous frequency was unrelated to the degree of compression. The EAS has two functional classes of mechanoreceptors: slowly adapting low-threshold and rapidly adapting low-threshold mechanoreceptors. These two classes of afferents are likely to be involved in the maintenance of continence, and the process of defecation.